Case.—Mrs. E. C., æt. thirty-four years. A tall, thin woman of neurotic temperament.
Family History.—Father had chronic bronchitis, but died of kidney disease. Mother was an invalid for seven years with rheumatism of hip and knee until death, which was caused by apoplexy; a sister died of gastric disease. The patient married eleven years; has two children living; boy at nine months died of entero-colitis; boy three and one-half years died of fall from window; two miscarriages. At ten years æt. the patient had diphtheria; at twenty-six, pleurisy; at thirty-one years, rheumatism of left shoulder and post-cervical region. It is impossible to obtain any indication of hereditary predisposition.
Subjective Symptoms.—Complains of post-nasal dropping of mucus, constant short hacking cough, malodorous breath, pain in region of spleen; aggravated when lying down and throbbing in character when walking rapidly. After discovering the swelling in the throat and speaking of it she admitted there had been a sensation of a lump in the throat for about a year, but so slight she considered it of little consequence.
Objective Symptoms.—Nares: Rhinitis sicca, covered with dry crusts, but turbinated bodies hypertrophied.
Naso-pharynx and pharynx: Mucosa slightly hyperæmic, follicles inflamed and enlarged. On the left side of these cavities is a sessile swelling, the general surface of which is much inflamed, and half of the surface is covered with varicose veins about one-eighth of an inch in diameter; it extends more than half the width of the pharynx and vertically from the vault above to the lateral sinuses below; is neither painful nor hyperæsthetic; it has a boggy feel, but not as soft as an abscess. The tumor springs from the posterior wall of the pharynx, not connected with the tonsil, as the left posterior pillar lies in front of the neoplasm and can be lifted free from it. Neither of the tonsils is inflamed nor hypertrophied; a few cervical lymphatics on the left side are slightly indurated, but slightly sensitive—if at all.
The swelling had probably existed longer than an abscess would be in forming, and there was neither pain nor fluctuation. Still an exploratory incision was made, but with the expected negative results.
Although the tumor was situated over the principal chain in lymphatics of the pharynx, it was not nodular, but smooth. Therefore the neoplasm was probably not of lymphatic origin, but an implication of the muscular tissue behind the pharynx.
A specimen was submitted by Dr. Klotz, the pathologist of the hospital, and the provisional diagnosis of angio-sarcoma made—sarcoma because it seemed to spring from the muscular tissue and apparent predominance of blood-vessels, and of the angiomatous variety because of the enlarged blood vessels on the surface.
The removal of the specimen for microscopical examination caused quite a severe hemorrhage, lasting about two hours, notwithstanding the employment of the usual hemostatics.
The microscopist pronounced it a small round-celled sarcoma.